Official websites use. Share sensitive information only on official, secure websites. Sepsis-associated brain dysfunction has been linked to white matter lesions leukoencephalopathy and ischemic stroke. Our objective was to assess the prevalence of brain lesions in septic shock patients requiring magnetic resonance imaging MRI for an acute neurologic change. Seventy-one septic shock patients were included in a prospective observational study. Patients underwent daily neurological examination.
Brain MRI was obtained in patients who developed focal neurological deficit, seizure, coma, or delirium. Electroencephalogy was performed in case of coma, delirium, or seizure. Leukoencephalopathy was graded and considered present when white matter lesions were either confluent or diffuse. EEG malignant pattern was more frequent in patients with ischemic stroke or leukoencephalopathy. Ischemic stroke was independently associated with disseminated intravascular coagulation DIC , focal neurologic signs, increased mortality, and worse GOS at 6 months.
Brain MRI in septic shock patients who developed acute brain dysfunction can reveal leukoencephalopathy and ischemic stroke, which is associated with DIC and increased mortality. It is clinically characterized by an acute alteration of consciousness, ranging from coma to delirium, and less frequently by seizures or focal neurologic signs [ 1 , 6 ].
The neuroradiologic correlates of these symptoms are poorly known, as few imaging studies have been carried out in septic-shock patients. In a preliminary study of nine septic-shock patients who underwent a brain MRI because of an acute neurologic alteration, we found ischemic stroke and confluent or diffuse white matter lesions which we called leukoencephalopathy in two and five patients, respectively [ 7 ]. These findings provided insight into the pathophysiology of sepsis-related brain dysfunction.
The demonstration of ischemia suggests the importance of cerebral perfusion impairment and microcirculatory dysfunction, whereas leukoencephalopathy is indicative of a range of pathologic processes including impairment of the blood-brain barrier, axon loss, gliosis, dilated perivascular spaces, and lacunar infarcts [ 1 , 7 ].
